Health care can hurt you

Sun’s investigation of Nevada hospital data shows 969 incidents of inpatient injuries — some that can be deadly

Jack Rode’s companion of 28 years, Donna Wendt, died March 13, 2009, at Sunrise Hospital & Medical Center after her windpipe was torn open during the insertion of a breathing tube, causing oxygen to be pumped into her body instead of her lungs. Decorations that Wendt put up in December 2008 still hang.

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Among life’s core assumptions is that hospitals bring healing. But sometimes they bring harm.

Rosie Powell’s surgeon removed a mass from the 74-year-old’s abdomen, thinking it was a cancerous tumor. It was a healthy kidney.

Donna Wendt’s windpipe was torn during insertion of a breathing tube. Oxygen was pumped into her chest cavity instead of her lungs, bloating her. She couldn’t be saved.

Tyrone Bush developed gaping, bone-deep bedsores on his buttocks and heels while recovering from heart surgery. Two years later, he can barely walk.

Morry Janovitz was a day from being released from the hospital when he was found on the floor of his room with a broken neck. He suffered for months from the complications before dying.

They’re not alone.

Over a two-year period — 2008 and 2009 — patients suffered preventable injuries, life-threatening infections or other harm 969 times during their stays in Las Vegas hospitals, an exhaustive Las Vegas Sun investigation has found.

Until now, neither the scale of avoidable incidents nor the hospitals where the harm occurred have been publicly known, in part because hospital lobbyists have resisted the state’s efforts to make the information more public.

Those details are now seeing the light of day.

The Sun has obtained and analyzed a state database in the course of a two-year investigation into the quality of Las Vegas hospitals. The information gleaned from 425,000 inpatient visits tells a story of preventable harm, deadly infections and possible neglect — at a rate of about one injury per day.

Dr. John Santa, director of the Health Ratings Center for the nonprofit organization Consumer Reports, said the events identified by the Sun are important indicators of how hospitals set priorities on patient safety.

“These are events that no one can be proud of,” Santa said. “They aren’t inevitable. They’re preventable. It just involves attention to detail and a willingness to change the culture.”

The Sun’s findings also call into question how well Nevada protects patients from being harmed in hospitals, because it appears the hospitals are failing to report many incidents. State regulators, with whom the Sun’s findings were shared, said they will investigate.

The Sun’s analysis reveals a host of problems encountered by patients, and troubling trends that the hospitals should address. Inpatient hospital records provided by the state show:

• 21 cases in which hospital patients accidentally had foreign objects left in their bodies after surgery — eight at University Medical Center, seven at Sunrise Hospital & Medical Center, three at Valley Hospital Medical Center, two at Southern Hills Hospital & Medical Center and one at Summerlin Hospital Medical Center.

• 79 cases in which a hospital patient developed an advanced-stage pressure sore — an open wound that can hollow out flesh and reach the bone. Sunrise had more than double the rate of any other Las Vegas hospital, with an average of 9 cases per 10,000 inpatient discharges.

• 475 cases of bloodstream infections involving central-line catheters — flexible tubes implanted into main veins to quickly introduce medications. St. Rose Dominican Hospitals, which have perhaps the best reputation for care in Southern Nevada, had by far the highest rates. St. Rose Dominican Hospitals — Siena Campus had more than double the rate of any non-St. Rose hospital in Las Vegas at about 27 per 10,000 inpatient discharges.

• 248 cases in which hospital patients suffered postoperative falls or other trauma. Southern Hills Hospital & Medical Center and North Vista Hospital had almost twice the rate of other Las Vegas hospitals.

The data show 79 instances in the 13 area acute-care hospitals where the harmed patient died. It is impossible to determine based on data whether the hospital-acquired complication contributed to the deaths.

All but one hospital refused to be interviewed to discuss these findings.

The numbers beg for comparison with other regions, but because there are no standardized public reporting methods, it is not possible to make such comparisons.

The federal Centers for Disease Control and Prevention tracks cases nationally of hospital-acquired infections and injuries, but no hospital-specific data are available for public review. Likewise, the Centers for Medicare & Medicaid Services, the government’s insurance payer, tracks such cases, but doesn’t make the information available to the public.

Tyrone Bush and his wife Martha sits in the waiting room in their lawyer's office in downtown Las Vegas Friday, June 11, 2010. In September 2008, Bush had a quadruple heart bypass operation at Desert Springs Hospital Medical Center. The operation was successful, but he developed severe decubitus ulcers, or bedsores, on his buttocks and heels after not being turned or moved enough in his hospital bed. Two years later, Bush cannot work, the wounds are still healing and still cause him severe pain. The Bush's have filed a lawsuit against Desert Springs.

Santa said trying to compare results by state or by hospital leads to “tower of Babel” confusion because so many different measures are used.

In fact, he said, comparing the numbers with other hospitals or regions misses the point. “An argument can be made that anything other than zero is unacceptable.”

But against other national benchmarks, Las Vegas hospitals fare poorly. The Sun found they have higher than expected rates of accidental punctures and lacerations, blood clots and deadly blood infections. Hospital insiders tell the Sun that a dangerous culture of mediocrity has become the status quo. Profits, they say, come before patients. When it comes to staffing, some hospitals try to get by with less.

The incidents of harm identified by the Sun should not happen.

Bedsores are almost always preventable, according to the Institute on Healthcare Improvement, a national nonprofit organization committed to improving patient care. The presence of severe bedsores suggests patients are not receiving proper assessment and care.

Similarly, central-line infections can be prevented with good hand hygiene, daily monitoring of the intravenous catheters and prompt removal when they’re no longer necessary. Researchers famously almost eliminated them from 100 intensive care units in Michigan and their methods are being adopted nationwide.

And a surgery unit at MD Anderson Cancer Center in Houston reduced falls by 75 percent in nine months through improved fall-risk assessment and providing assistance when patients need help most — when they go to the bathroom.

BENEFITS OF TRANSPARENCY

The database tapped by the Sun can be analyzed to identify the hospitals that provide the safest and highest quality care, and those that have repeated incidents of harming patients — making it a potentially powerful tool in deciding where to seek care.

“The more transparency there is the better, (so) consumers can choose their health care facilities,” said Assemblywoman Sheila Leslie, D-Reno, an advocate for improving health care. Such information also benefits insurance companies, which “want to send their insureds to the best possible facility,” she said.

In October 2008, Medicare stopped reimbursing hospitals for preventable “hospital-acquired conditions,” another name for the events identified by the Sun. (The Sun followed Medicare’s lead in determining how to cull the incidents of patient harm from the billing data.)

Medicare’s move addressed the perverse incentive facilities have to not correct harm done to patients: Most insurance companies pay them to treat the hospital-acquired conditions. The injuries can be moneymakers.

Leslie Johnstone, executive director of the Health Services Coalition, which is made up of 24 self-insured health plans in Nevada that cover 260,000 people, said she will study the Sun’s report for trends in poor care at particular facilities or hospital chains. That analysis could prompt insurance payers to direct patients to hospitals with the best care or refuse to pay for ongoing complications that are caused by the facilities, Johnstone said.

The insurance companies have been pushing hospitals to improve. Coalition members could take Medicare’s approach — not pay — if hospital harm can be verified. “That would be a strong argument for why the payment should not be made,” Johnstone said.

FIGHTING TRANSPARENCY

Courtesy of Pamela Janovitz

A courtesy photo of Morry Janovitz taken by his wife Pamela after his first fall in Spring Valley Hospital. In late 2008, then 82-year-old Morry Janovitz was admitted Spring Valley Hospital for pneumonia, and the day before he was scheduled to be discharged, he was found on the floor of his hospital room, his neck broken and forehead gashed. Two weeks later he was found on the floor again, this time with just a bruised elbow. Janovitz died from complications three months later.

In 2007, lawmakers passed a bill requiring the state to report, by facility, incidents that harm patients. The state has been conducting the same analysis as the Sun, using the same data and methods. The mandate was for the information to be posted on a website so consumers can compare hospital quality.

According to sources, the state’s effort is yielding the same findings as the Sun’s.

Implementing the legislation has been beset by inaccurate reporting by the hospitals, particularly University Medical Center, as well as budget cuts.

Because of the fiscal crunch, the Health Services Coalition has helped finance the state’s project.

Chuck Duarte, administrator of Nevada’s Health Care Financing and Policy Division, wrote about the tension in an e-mail Oct. 14 to his supervisor. He reported that Bill Welch, president of the Nevada Hospital Association, said that posting the information by individual facility may prompt hospitals to muddy the information to prevent the events from being identified.

Welch “also suggested it could lead the NHA to file suit against the state as (the hospitals) are very concerned with their tort liability if hospitals are identified,” Duarte wrote in the e-mail.

Welch said in an interview with the Sun that he told Duarte the hospital association would challenge the state, but never mentioned litigation.

When the hospital lobbyists learned the Sun had obtained the data, they complained to the state that the Sun’s analysis had violated federal patient privacy laws. (The information is public record, and state officials said the Sun did not violate privacy laws.)

UNDERREPORTING THE DATA

Hospital lobbyists and Nevada legislators have spent many hours haggling over transparency laws. The resulting legislation does not benefit consumers as much as it could.

Even so, the Sun’s investigation found hospitals may not be living up to their end of the bargain.

In 2002, during the special session of the Legislature to address doctors’ rising malpractice insurance rates, lawmakers created a registry where hospitals would be required to report “sentinel events” — defined by state law as unexpected incidents that cause serious physical injury or the risk thereof. Sentinel events are deemed so significant that, by law, they trigger internal investigations to determine the cause of the problems and corrective plans to prevent similar harm in the future.

At the time, Welch questioned whether medical error reporting was worth the cost. No study shows that mandatory reporting measurably reduces the errors, he said, according to minutes from the legislative session. The reporting risked compromising patient confidentiality and the physician peer review process and would be costly for hospitals and for state regulators tasked with additional oversight, Welch said at the time.

“The hospitals have been resistant to change every step of the way,” said Assembly Speaker Barbara Buckley, a proponent of the sentinel-events legislation.

The intention, she said, was to increase hospital transparency, reduce costs associated with errors and improve the quality of care.

As a result of negotiations between legislators and hospital lobbyists, the only part of the registry that is public is the total number of sentinel events statewide. Hospital-specific breakdowns are not available, rendering the information essentially meaningless to consumers.

The Sun’s analysis of inpatient records suggests some hospitals are not reporting all of their sentinel events.

The 1,363 incidents of statewide hospital-acquired harm identified by the Sun from the 2008 and 2009 data seem to fit Nevada’s definition of sentinel events. Yet during that period Nevada hospitals reported only 402 sentinel events.

The 2009 data, which the state reported more specifically for sentinel events, provides the best comparison with the Sun’s findings from the hospital inpatient data. For that year:

• Hospitals reported only one sentinel event involving an advanced stage decubitus ulcer — a bedsore that becomes a crater surrounded by dead flesh. The Sun found 72.

Rosie Powell sits on her couch inside her home in Henderson Thursday, May 27, 2010. Powell went in for surgery at St. Rose Dominican Hospital's Siena campus on April 4, 2008, and during a procedure to remove a colostomy bag, surgeons removed Powell's right kidney, which they mistook for cancer. A CT scan following the procedure also revealed a hole between sutures at the site of the colostomy takedown, and after three more procedures to repair the leak Powell now has an ileostomy bag on her right side because of the complications. She is too traumatized to return to the doctor to get it removed. It is hard for her to lay down so she has to prop herself up with pillows to sleep.

• Hospitals reported six sentinel events in which a foreign object was accidentally left in a patient’s body. The Sun identified 17.

None of the hospitals disputed the Sun’s findings. But they argue many of the incidents identified by the Sun don’t rise to the level of a sentinel event. They call them “adverse” events. (An adverse event is usually defined as a hospital-acquired complication that harms patients, but the term has no legal bearing in Nevada.)

Hospital officials appear to have discretion in determining whether a hospital-acquired injury fits the sentinel-event definition of “unexpected” or causing “serious injury” or the risk thereof. Most wouldn’t discuss that issue on the record.

Officials from almost every hospital in Las Vegas refused to be interviewed for this story. Welch said the hospitals were afraid to speak to the Sun because an interview might violate the federal Health Insurance Portability and Accountability Act, better known as HIPAA, which protects patient privacy. Other medical authorities scoffed at that suggestion.

The only hospital executive who would speak to the Sun for this article was Patricia Scott, vice president of quality for Iasis Healthcare Corp., owner of North Vista Hospital.

Scott said each medical record must be examined before conclusions can be drawn about whether an incident should be reported as a sentinel event. Hospitals take into consideration the course of the patient’s illness and condition, for instance, before determining whether an adverse event was unexpected, she said.

Leslie, the primary author of the state’s sentinel events definition in 2002, said the events identified by the Sun appear to be sentinel events and should be reported as such.

Buckley said, “The hospitals need to explain what happened and then they need to correct the data.”

The state has had no mechanism to determine whether hospitals have been accurately reporting sentinel events. Regulators have trusted the hospitals to do what’s best for patients.

That’s about to change.

As a result of the Sun’s investigation, Richard Whitley, administrator of the Nevada State Health Division, which licenses hospitals and investigates complaints against them, said he would ask hospital administrators to report any previously undisclosed sentinel events. State investigators will then pull medical records to determine the accuracy of each facility’s sentinel events reporting, he said. Nevada can fine hospitals for inaccurate reporting of sentinel events.

In addition, the Health Division will start its own analysis of the same inpatient data examined by the Sun to supplement its own investigations, Whitley said

“Since the Las Vegas Sun identified this analysis of data, we are certainly going to make use of it as well,” Whitley said. “It’s all about improving the quality of health care.”

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What's more scarey is if Universal Health Care kicks in there will be less Doctors with more demand and it will be even harder to oust these butchers from their practices just because of the demand. You listening Obama?

Hi dhvincent1 - we mentioned in the story that it's impossible to compare to other states, because everyone keeps data in such different ways. You're hitting on something that's a major bummer - there are no national guidelines for reporting these kind of things that everyone follows. And some of the guidelines that do exist do not provide for transparency for the public. They keep the info internal.

Also, with the 969 Las Vegas events we reported here, the real comparison is to zero. These events are all preventable and should not be happening.

Perhaps the Sun should heed the title of "Do No Harm". This will serve little purpose other than to scare the public with incomplete data. Anyone with any medical exposure will tell you that applying statistics such as these to medical practice is nearly impossible even for the most educated and practiced in the medical field so I don't believe two Sun reporters - even if they are trained in "crunching numbers" - have solved this challenge.

Readers should read with a critical eye - know that some of the best doctors in the world see some of the worst cases simply BECAUSE they are the best. With that comes risk and even mistakes - things that even the best in the world can't avoid. Medicine is NOT perfect no matter how much we wish it would be. Unfortunately, there are more attorneys (and now reporters) that wish to profit off these tragic circumstances.

These cases are sad and horrific and much sympathy is due to those affected but the only thing that I think will come of this are frightened readers and some unfairly damaged reputations.

mrob32, a few quick points:1. In terms of the reporters' competence in sifting through and analyzing the numbers: The reporters shared the data with the hospitals, and not one hospital disputed the findings. 2. The alternative to not "frightening" readers, as you suggest we've done, is to not factually report the incidents of patient harm occurring at hospitals. Is that a more responsible decision, to ignore the information?3. I'm at a loss as to how the reporters will "profit" by these stories, any more than reporters anywhere profit by doing good journalism that informs the community.

This is tremendously important reporting and I am heartened to see it. You in places referenced the incidence of given events per 10,000 patients. I would love to see all of the events broken down this way, including scaling in your graphic representation.

And to mrob32 -- I agree that the very best doctors get and should get the most difficult cases. I do not agree however that statistics cannot be applied to treatment. We are talking about IV infections, which almost entirely result from 1. not washing hands, and 2. not monitoring the catheter. We are talking about bed sores, what is more preventable?

We all know mistakes can happen, but a lot of what was reported in this article seems like pure negligence. How does a doctor (even the "best") mistake a healthy kidney for a cancerous mass? That seems really crazy to me. I'm sure that doctor was trying to be "proactive", but (not to be super critical), couldn't they have done some sort of biopsy if they were unsure before removing it? I'm not trying to be sarcastic; I really would like to know. Yes, mistakes can happen, but there are certain professions (doctors, police, etc) that society holds to a higher standard, and mistakes should be minimal.

I've noticed the data on the infographic Preventable Harm shows all the data on as they happen per an unsteady number of people. Could you release another infographic with a solid number so one can get a better idea of the percentages at which they occur? For example, showing all injuries as they happen per thousand (1,000) people, thus showing one's statistical chance of sustaining a preventable injury in each hospital.

When the starting assumption by the reporter is: "health care in Las Vegas is bad," the resultant numbers can be used to prove his point. Clearly, the examples shown are horrendous. But, yet Mr Allen does not do the readers a favor by leaving out important data. That is what are the rates of errors at hospitals such as Mass General, Johns Hopkins, UCLA etc? The data suggests that busy hospitals have more errors (Sunrise, St Rose Sienna, UMC), whereas a new hospital like Centennial Hills has few. Once again the sample size is not known. Most of these errors should be avoidable. Hospitals are trying to correct them given increasingly lower reimbursement(medicaid, medicare, etc). Will the hospitals ever be perfect...No. Yet, there are some, but not enough checks and balances. The Joint commission accreditation is one, medical staff is another, the nevada medical board is a third. Finally, the trial lawyers are the last. The article is good in that it raises public awareness and opens up a discussion of an important issue. The most important aspect of patient care though is family involvement, asking lots of questions and finally good luck.

The infographic does show the rate of incidence. Take another look at each column, and alongside the raw numbers is, in half-tone, the rate per 10,000, or per 1,000, or per 100 depending on the category.

We would caution you: these rates are based on historic data and are not intended to reflect a patient's statistical chance of sustaining a preventable injury in the future.

Hi dominicki, you can see the rates for the various incidents using the interactive graphic. Sort it by "event" and then click on each event, and it will give you the rate of their occurrence.

These are relatively rare events, so the rate is either per 10,000, per 1,000 or per 100, depending on what made the most sense.

Also in the interactive graphic, you can sort by "hospital" and mouse over each hospital's results to get the total number of each incident by facility.

The total numbers of each event (and the rates, which are shaded) are probably easiest to see as a group in the static graphic with all the types of events and all the hospitals. That's also under the "See the results" subhead on this page.

Folks, I removed my own comment because Marshall beat me to it while I was also posting. But I'll add, for sampson1, that we understand your frustration that the data for Las Vegas can't be compared to other regions, or to other hospitals outside of Las Vegas. As this story points out, "The numbers beg for comparison with other regions, but because there are no standardized public reporting methods, it is not possible to make such comparisons."

As we've said in the stories, it's impossible to make the type of comparisons we all desire because the data is kept differently in other places and little of it is public. As Dr. John Santa from Consumers Union told me, it creates a "tower of Babel" type problem when trying to compare because everyone is comparing different numbers. So we're not leaving any important information out. That info does not exist in a way that allows for comparison.

Please also remember, as Santa from Consumers Union also said, that the real comparison for these type of events is zero. They are all preventable and should not be happening. Comparing us to other regions is the wrong comparison.

As for your allegations about us being biased from the outset -- as we've documented in this package of stories, Nevada hospitals have the worst 30-day readmissions rates in the country for Medicare patients. That was revealed in a study by HealthInsight, the Medicare quality improvement group here in Las Vegas.

You can see that report by checking out the "documents" tab on this site. It's called "Health Insight Readmission Report." According to the report, 25 percent of Medicare fee-for-service beneficiaries are readmitted within 30 days, compared to an average of 19 percent nationally. Those readmissions cost $203 million and up to half of them are preventable, the report said.

We also rank poorly by other national measures, and the Health Services Coalition, the group of 24 self-insured companies here in Nevada, is pushing the hospitals to improve, as well.

For years, I used to donate yearly to the Jimmy Fund, a Boston based fund anchored by the Red Sox. Its primary beneficiary was the Dana-Farber Cancer Institute. One of my good money years, I was highlighted in their fund raising magazine. Then one day, they were found to be performing shortcuts, short of staff, and doing other shady things. They were fined thousands of dollars. And they never received another dime from me.

I'm going to St. Rose Siena for double knee replacements in a couple of weeks. I was actually considering going overseas, to India, for the operation. Maybe I should reconsider, to avoid complications from going to one of Nevada's hospitals. What a sorry, sorry State.

Mr. Gorman, your response just reinforces the point raised by samson1 - you are simply supporting a conclusion by compiling data, not objectively analyzing data to form a conclusion. In response to:1. I'm not disputing your data, I'm just pointing out that medical data sets, of which I am familiar, commonly have dozens of variables and still can prove inconclusive as to the causes and conclusions. My lack of confidence is that there seems to be a very limited amount of context to this data and the conclusions made. It doesn't take a rocket (or medical) scientist to know that how and to what extent you present data can get you the conclusions you wish to get across.2. No, I don't expect you not to report, but I find it irresponsible to report in such a manner that leads readers to think it is a comprehensive investigation when it quite obviously is not. Just because hospitals or physicians don't respond (likely at the advice of legal counsel) does not mean they are hiding something or are negligent. You present but one (limited) side to a very multi-faceted situation.3. Profit? I'm sure you don't need me to remind an employee of The Sun about the benefits of these exposes to the reporters and publication after the 'success' of the efforts regarding employee safety on construction sites - you can't look at a page of this site without being reminded of the Pulitzer. If your goal was truly as altruistic as you claim, your conclusions would come from even reporting from all sides.

scott_swank:I don't disagree with your points. All I'm saying is that none of us know what that surgeon was faced with in that operation. I would suspect it was complicated - far beyond what we laymen could understand. My beef is that this piece does not present those sides of the story.

Regarding the other things - again, I don't disagree, but there is MUCH more to these stories from the perspective of the doctors, nurses, hospitals, etc. For instance, bedsores are 100% preventable, but there are many variables as to why this would happen - could have been bad nurses, could have been great nurses but they were understaffed. Who knows.

This is a very big issue to our community and society, I just think everyone should think critically when only given one side of the story.

The source data analyzed by the Sun -- raw information reported by the hospitals to the state -- do not reflect causes or conclusions, and neither do we. The data are what the data are, and the newspaper is simply reporting it publicly for the first time.

The reporting was absolutely even-handed. We should not report on a story if one side doesn't want to talk about it?

I'm not sure how to respond to your third point. We shouldn't report important stories because it might reflect well on the quality of our journalism?

This is an excellent article and "eye-opener" It points out the severity and broad-range of injuries that needlessly occur. Such injuries, as shown in the article's database charts (see above: "records provided by the state show"), should alert everyone to the NEED FOR CLOSE OBSERVATION of a patient's condition, comfort, progress - and the nursing activities.

Such observations by family or friends, are necessary for the patients welfare - in ANY hospital, or clinic; in any State. By close observation, I do not mean being a PEST to the nursing staff.

Me and my family have benefited greatly from using the doing the following things. While this article presents a great discussion of the problem, I wanted to share some SOLUTIONS my family and friends have used, to avoid the occurrence of PREVENTABLE INJURIES. ANYONE CAN DO THESE THINGS.

1. BEFORE the patient is admitted (non-emergency) get the patient to put YOUR NAME (and others) on the hospital's record (HIPPA "LIST") that designates who people are that the patient authorizes to have information them. During an EMERGENCY admission, you can do the the same thing by showing a relationship to the patient.

2. THIS IS IMPORTANT: Family members and friends should make DAILY VISITS to see the patient - for an hour or more. Your frequent visits and presence will show the nursing staff that someone is interested in the patient's well-being. Such visits may also help to develop a RAPPORT with the nurses - which, in turn, may benefit the patient.

3. You should ask your questions from doctors and nurses in a casual manner. You can also convey questions the PATIENT has asked you to ask (due to ability, language barrier, etc).

4. DO NOT ask all your questions at the same time. The nurses are busy. BUT if the patient is in trouble, or needs something, ring for the nurse.

5. DO NOT DO ANYTHING - other than pouring some water, or adjusting the a TV. But respect the patient's desires. There can be many reasons why things like a pillow, the bed height, or bed covers should NOT BE MOVED. Ask the nurse to do such things.

6. You can ask nurses and doctors about the patient's progress, problems, making the patient more comfortable, additional procedures that become necessary, etc.

7. But express your thoughts GENTLY. Ask the doctor if you need more information. Also, ASK if you can help the patient to the bathroom, bring a gift, etc. BOTTOM LINE: DO NOT DO ANYTHING without asking a nurse first.

I think it would also be useful if the LV SUN would run an article along these lines as a public service - to give people ideas as to how they can help patients avoid many of the preventable injuries described herein.

By TedBundy - As to your knee surgery, I would NOT go out of the USA for this surgery. You wil need an orthopedic doctor (I believe), for follow-on,check-ups, prescriptions, xrays, specialists for therapy, etc.

Plus, a U.S. doctor may not be as dedicated to your post-surgical condition as he/she might be if they performed the surgery themselves (and hopefully could avoid potential things like: failure of function, infection, use of incorrect procedures, sub-par replacement parts, etc.).

I would look "nearby" (or elsewhere)to the Mayo Clinic (n Phoneix - even if just for a referral); Cedars-Siani Hospital or UCLA in California, or for other doctors and hospitals where you can find credible referrals for the kind of surgery you need.

Last point - after surgery - DO EXACTLY what your doctor tells you to do. Report any pain, or adverse conditions.

I have a female friend who had an ANKLE replacement (from cadaver tissue) that worked. It was a new surgery at the time - six years ago. But she did everything the doctor told her, such as staying OFF the foot, using crutches, etc. - to allow the surgery to "take" and heal (about 3-5 months).

She told me a few other people who came later, had the same surgery from the same doctor - but it DID NOT WORK. Reason: they walked on the ankle, did not keep their leg elevated, etc., etc. I think you get the point.

My father went to Mt Vista for Lung Cancer surgery last may. The surgery went great. What was supposed to be a seven day stay turned into a 30 day. He was extremely over medicated throughout the stay. To the point of hallucinations. The day before he was supposed to be released he began bleeding internally from an undetected ulcer. The problem was the nurses would not respond to his calls for help. Why, because it was later determined they were sleeping at the nurses station.By the time they finally came to his room he practically bleed to death. They called my mother at 3 in the morning telling her they didn't think he was gonna survive. Imagine our shock. He was suppose to be release that morning. They were able to stop the bleeding ulcer but the damage had been done. He laid unconscious and in worse shape then when he arrived. To top it off the hospital recommended he be transferred to an after care facility for a mandatory month. I refused!! At this point he had already lost his mind due to the over medication, horrible treatment by the nurses, severe bed sores and the trauma of bleeding all over the place and no one to help. They told me there was no way he would be able to go home. I knew in my heart if I sent him anywhere but home he would not survive. Within 24hrs of being at home his mind came back. The recovery process has been very slow. I feel sorry for all those people who don't have someone to stand up for them. I honestly believe most people sent to "recovery" facilities should never be there. They just didn't have someone to take them home. Very sad!!! I can only imagine how treatment will be with National Health Care. You think its bad now...Just wait.

Hospitals are the place to go if you wish to die, and die broke. They will suck you for every last dime you and your family possess. They elude to a cure til they find out you have no more money. Then there is nothing more they can do for you. This is expecially true in LV. It's all about money, honey! Not about medicine. You will die there or wish you had.

Excuse me, but I enjoyed reading the article, and was amused by the comments. Maybe bemused is more to the point. The voices told me to warn everybody now! Watch out for the superbug. I left my liver in San Francisco, but am saving for a new one, gonna take the midnight express to Shanghai, maybe get a new kidney, also, if they offer a 2 for one special.

Thank you for responding to my points. All of these problems should not happen, but they do because humans are imperfect and make mistakes. It takes issues like these to start a discussion on how to better care. Medicare is not reimbursing hospitals for errors. Therefore, it is in the hospitals best interest to improve care. There are investigations into these incidents when they occur in the hospital. The doctors are disciplined. Yet like all other facets of care in this state and in others, doctors show up to these hearing with lawyers and of course there is often little to show for such effort. I have lived in many areas of the country and have gone to many teaching hospitals. I assure you that I would rather have an experienced doctor treating me than a resident with in some cases a day or two under their belt after medical school. Is the care here great, in some cases yes, in others no. However, shining a spotlight on the subject helps. The stories presented are tragic (most disturbing though is removing a normal kidney). Going out of state and out of the country is like wearing a designer label. They are both made in the same factory in China. The placebo effect does help many, yet practically, it doesn't change the paradigm. Thanks for a good read.

As "By jazzy13" says, there are many people [with and without health care] who will not survive a hospital visit. The reasons are many; a lot to do with money.

"By samson1" said: (to help yourself) "ASK A LOT OF QUESTIONS....." That may be another one of the biggest things you (your family and friends) can do - besides observing what is going on. This can save a patient's life.

to increase your chances of surviving a hospital stay, is essential that you have a GOOD DOCTOR who knows you, will watch out for you, and will take care of you - even if he/she is only your "primary care" doctor.

Tell your family doctor (and others) that you are going to a hospital, and why - BEFORE YOU GO.

These preventable injuries are, indeed, a sad problem for many millions of people. The cost incurred can be as devistating as the condition - or the hospital stay.

I am glad that people are posting helpful thoughts, experiences, and stories - which may be useful to others.

Good medical insurance and good doctors are equally important. Getting both is not easy. I had to work hard to find my current doctors who would listen to my concerns, track my ailments, amd examine my symptoms - as I thought they should. And MOST IMPORTANTLY - get me well!

It is also unfortunate that medical care (outside of an emergency room) is not available to everyone who needs it; and it will never be - even with the new health care law.

You cannot divide 30 million new patients over the number of doctors curretly practicing in the US, and serve about 300 millin people, nor expect equal attention to be given to everyone's illness.

As we all know, it takes two weeks to see a doctor NOW. The impending expansion of health care in the US will only excerbate the problems of doctor availablity, costs, and number of people who cannot be treated in a timely manner.

If you agree that the economy is broke now, wait until "health care" kicks in next.

By the way, my SOLUTION is to establish government (not welfare) clinics in every city around the country (similar to what exists now) - but subsidize the nurses and doctors who would be "first responders" attending to a sick people. If more indepth care was needed, referrals to doctors or hospitals would be made - but the sick person WOULD still be seen.

SanLucas,Please explain to me how the headline disagrees with the data. It is what it is. Nearly 1,000 patients over two years were hurt while receiving hospital care in Las Vegas-area hospitals. That's what the hospitals' own data says. They reported it to the state, and the Sun is reporting that information to the readers.

As for better context to the numbers, that would be nice -- but there is not more information in the data reported by the hospitals to the state, in part because that would violate patient-privacy laws. The kinds of details you seek are not available to us.

What you are doing Mr. Gorman is editorializing. I never said you shouldn't report - you most definitely should - but this is simply getting on a soap box and pointing a very broad finger.

I'm not at all suggesting that because the other party won't comment you shouldn't run the piece. But just because they don't comment, doesn't mean the other side(s) of the story don't exist and these pieces fail tremendously in acknoledging them.

As for my third point, get all the recognition you can, I'm all for it. Just don't pretend The Sun does this for pure altruism and isn't making a business out of these 'projects'. If it were about the journalism you would be more concerned with getting the whole story...but then again, I'm not a journalist so what do I know.

Thank you for publishing such an important article. Although I would like to have seen more background as to how this data was collected (ie. medical billing codes, DRG's, sentinel event reports, etc.), I do think this is an eye-opening issue in Las Vegas.

But patient safety is not selective to our city alone. Hospitals across the country have struggled with improving healthcare for years. In 1999, the Institute of Medicine published a report entitled "To Err is Human" in which they estimated that as many as 98,000 people die any given year from medical errors. Since then (thanks to accrediting bodies such as JCAHO) multiple required safety measures have been put into place.

Unfortunately, medical errors and patient safety are not a hot-ticket item in the eyes of legislators, therefore, funding to improve our healthcare system is not adequate. For instance, when the AIDS epidemic entered our society, it took massive funding from our government to research the disease and to educate the public on prevention.

If we want to see improvement in the quality of our hospitals, we're going to have to see it come from the top. Not until we treat medical errors like an epidemic will we be able to make significant improvement.

The issue is not the condition of the patients when they entered the hospital for care. The data being reported by the hospitals to the state, that we're passing along, are the incidents where something happened to the patient while in the hospital that worsened his or her condition, something that was preventable and avoidable -- incidents for which the patient is not culpable.

It sounds like you want to blame the patient for incidents for which the hospital, by the government's definition, is responsible.

The data, as explained in the stories, reflects billing codes at the time of discharge for inpatients -- including information on whether the condition was present at admission.

The hospitals' reporting of sentinel events is aggregated statewide and does not provide hospital-by-hospital information.

The Sun, using Medicare's methodology, was able to identify the same basic incidents that the state defines as "sentinel events," and that is the information that the newspaper is reporting on a hospital-by-hospital basis.

In the course of the analysis, the Sun found more sentinel-type events than were reported by the hospitals. It is that discrepancy that has already triggered a state investigation into the hospitals' self-reported data.

This type of reporting is great to see, because there's not enough of it in Las Vegas.

In general, this state is lacking in oversight. The R-J, which should be a force for demanding oversight, is instead just a one-note anti-government rant rag.

I come from a northeast state where licensing and professional standards are a lot more stringent. You don't have to worry so much about docs there (or lawyers or teachers or real estate agents or...). Here, I'm always afraid.

But even where I'm from you must take responsibility, get the facts, and do your darnedest to care for yourself.

This excellent piece lost some points from me when I looked at the photo of the obese Bush couple. Is it any wonder that he wasn't turned enough? How many nurses would that take? No doubt more than the hospital would pay for. I'm not saying that's okay, but there does have to be some reasonable expectation. Hospitals cannot do everything for everyone all the time. Not turning this man is not in the same category as mistaking a kidney for a tumor or acquiring an infection because staff members don't wash their hands or something like that. His lack of care for himself is part of the problem in this case. People must take some responsibility for themselves.

Remember the incident last year of the woman who lost a baby after a very long wait in the emergency room, where she was in pain? But the woman didn't even know she was pregnant. So don't blame the staff for not knowing, for goodness sake. They're supposed to be able to tell whose pain is more real than someone else's when they're overwhelmed all the time with people who are ignorant and don't take care of themselves?

But that's beside the point. It's really great to see some serious investigative reporting. Looks like the Sun's going for another Pulitzer. Good luck, guys. Keep up the good work.

The real problem with this article is that the data reported show how many incidents of a particular type that a hospital has per 10,000 discharges, but not the percentage of all cases of a particular procedure that resulted in injury, etc. For example, one hospital might have a larger number of injuries from catheter insertion than the others but may have seen many more patients that required a catheter insertion. Percentages of a procedure done is the only valid data.

Many have suggested another Pulitzer is possible for the Sun. This subject has national importance and the Sun has a great start and important issues to deal with.

It was mention yesterday that Hospitals employ foreign physicians and RN's. I have found that the vast majority are excellent and smart as whips. Also, we can't imagine the burdens the foreign professionals went through just to become qualified and then pass State Boards.

Clark County has neurosurgeons practicing with no Board Certifications, some can't even pass the test to become certified but yet they have privileges at local major hospitals.

My wife and I (and family) are currently experiencing a "hospital debacle". Over FOUR MONTHS AGO my wife went in to Sunrise for "MINOR SURGERY". The operation took maybe 20 minutes. After about an hour in Recovery, my wife was released. Less than 48 hours later she became Septic and was transferred back to Sunrise via Emergency Ambulance. Within three hours of her re-admittance to Sunrise, my wife experienced three minor strokes and a heart attack (a balloon had to be inserted in one of her arteries).

FOUR MONTHS LATER (and in excess of $100,000 in medical bills . . . thank goodness I have relatively good medical insurance!)my wife is now in a rehab facility. Hopefully she will be released soon. Mentally however . . . she may never be the same.

This experience has caused my family unbelievable Hell.Our lives will never be the same!!!!

Perhaps your well written investigative reporting caused the State Board of Medical Examiners to focus on their job.

They finally found some stones and filed a complaint on June 16th, 2010, [case # 10-11398-1] against the big money partner @ Western Regional, William Smith MD, just as their partnership is undergoing major disruptions with fractured egos.

Seems in the referenced complaint malpractice was alleged, based upon a failed operation September 30, 2004.

A records search could probably retrieve other and similar prior issues.

Case looks strong against Dr. Smith and worth reading.

The point is that until injured patients and honorable medical professionals step forward, perhaps because of your contributing valuable insight and a strong voice at the Sun, nothing will happen to correct these injustices against the public.

Thank you, Sun, for bringing this to light. There is an assumption that malpractice claims are fraudulent and that lawyers are to blame for everything. That is bunk. As a patient, you are SOL if something goes wrong because the system works against you, and even if you have insurance it is devastating. If you don't have insurance, you're really in trouble. And it isn't hospitals who treat you (or fail to), it is doctors and medical personnel.

I would be interested to see how the stats tie back to specific doctors and nurses so that the hospitals could then revoke their hospital priveledges! But NO, doctors each have their own malpractice policy... you sue the doc, not necessarily a hospital and it is very disjointed... so let's see the numbers on the specific doctors/staff too? Because the medical board doesn't tell you anything- you have to look at the district court cases to find that! And those are only cases strong enough for an attorney to take them!

How does one report on all of the malpractice that doesn't surface in billing? Or outside of a formal hospital and within a surgery center for outpatient procedures? I believe if you looked at the numbers through that lens, we would be even more horrified with the results. There are many of us that are victims of malpractice for out-patient procedures. There is no hospital to sue, only a shoddy doctor. Oftentimes there is no insurance if it was an elective procedure... There is a whole population of patient care not being captured by these statistics!

A perfect example of the medical personnel being responsible for the care or the lack of, are the comments from x-doc and RebelRN, who essentially say an obese person isn't due the same quality of care, and doesn't deserve the same degree of treatment as someone else. ...That because they are overweight they "deserve" these dire consequences! I shudder to think how arbitrarily those two treat their patients, and they are not alone.

Please Sun, take a look at the doctors who have performed routine procedures that shouldn't have required follow-up care or other procedures but did, and outside of the big hospitals too. I fear the your findings would be much more far-reaching than the incredible information you have already uncovered.

Thank you for pursuing such a difficult and important topic Sun. Awareness is a huge help!!!

It's the nurses, stupid. When are people going to get it? Most of the day to day care in a hospital is done by the nursing staff, not the physicians. In a typical day at a hospital, the md will see you approximately 10 minutes. I however will be with you for the next twelve hours. If your health starts to go south during that time you had better hope to God your nurse is on the ball because by the time your md sees you umpteen hours later, you are most likely toast. And that's if he even notices. You see, much of what the physician sees regarding your care is charted by me. I am the one who notices if you stop urinating signaling renal failure etc.

It seems the only time we ever hear about the nurses is when they do something wrong. "Those lazy nurses..." Did it ever occur to you that maybe just maybe the reason the care is so poor is that because the nursing staff is stretched so thin that they cannot properly care for the patient. When hospitals cut costs, it is often the nursing staff they cut. And yes, they do put profits above patient safety. So the next time you are thinking of entering the hospital for a procedure ask how many nurses they staff per patient. It's the best darn indicator of quaility you are going to get.

I have worked as a nurse for fifteen years, and the disrespect that people heap on the nursing profession makes my blood boil. We are called lazy and worthless not only by our administration, but by the very patients we work tirelessly to care for. All people ever do is complain about how much money we make and accuse us of being lazy when we stand up and demand better nurse to patient ratios.

The truth is that nurses are the best damn bargain the health care system has. It takes a college degree to be a nurse and many years of training to be proficient. Much of the care and monitoring done in hospitals today is done by the nurses. Try paying an md to care for six patients apiece...talk about cost! But yet we are despised by everyone it seems, and they begrudge us our pensions and salary saying we are expendable and not worth it.

Sometimes I think people get what they deserve, and until the public starts respecting nurses and the nursing profession accidents will continue to happen and people will get hurt. Hospitals put profits before patients all the time, and the nurses have been shouting to the darn rafters, but all we ever get is suspicion, blame, name calling and disrespect. It's a main reason nursing is not seen as a more attractive profession to young people.

The only time nurses are ever mentioned is when they do something wrong or miss something. Never mind the countless numbers of nurses who work hour after hour against ridiculous odds and an administration that openly hates them to ensure quality care and positive outcomes. It is not our fault the hospitals cut staff to the bone. We can only do so much, and we cannot be in several places at once.

I just went through intense negotiations in MN where the nurses were theatening to strike over better nurse to patient ratios. We received zero support from the public. They called us liars, greedy, and worthless and suggested we all be fired. Good luck with that. The only people qualified to take on our level of responsibility would be an md. And the md would rather get a needle in his eye than put up with your stinky, whiney behind for twelve hours. The md gives orders, the nurses do the actual monitoring and work. And it is often the nurses charting and suggestions that prompt those orders in the first place.

Did it ever occur to you that some of those nurses at the beside who seem so cold and uncaring have simply given up on fighting day in and day out for a public that ignores or hates them? It's far better to simply go through the motions and collect the check because no matter how hard you try, the patient's aren't going to appreciate it anyway.

Hospitals and their administrators lie and obfuscate the truth to make the nursing profession look bad. Why you ask? Because if the public started respecting the nurses and trusting what they said, the truth would come out. And that truth aint pretty.

Any person who has ever made fun of nurses or called them names should wind up in a hospital bed someday completely vulnerable and at the mercy of one of those "lazy, worthless" nurses. Maybe, just maybe that nurse will have too many patients that day and won't get to your bedside for a long time leaving you and your illness to fester. Oh well, I guess the loss of your life or limb was worth the money the hospital saved by not hiring more of those "lazy, worthless" nurses. Gee, I guess you really can't replace an educated, skilled nurse with an unskilled laborer who gets all of six weeks training. Who knew?

I think karma is really going to bite you in the ass in a decade or so when the baby boomers really start hitting the system. The mistreatment and disrespect of nurses and our profession is driving more and more skilled nurses away from the beside care and into easier jobs like clinics or outpatient day surgery centers.

You won't be able to find enough nurses to care for the hospitalized and critically ill. And the ones you do have will be new grads without the benefit of the experienced nurses to mentor them. The loss of each skilled nurse from the beside is a devastating loss for patients, but ultimately an outcome brought on by yourselves.

God loves nurses. Of this I am sure. They are abused, lied about, mocked and spit on literally and figuratively until their spirit simply breaks down...that or their body gives out. At which point the hospital wants to simply kick them to the curb and forget about them. Just an expendable cog in the wheel they say...

God bless the nurses and the nursing profession. You are the last and often only advocate the patient has left.

Hospitals and their administrators lie and obfuscate the truth to make the nursing profession look bad. Why you ask? Because if the public started respecting the nurses and trusting what they said, the truth would come out. And that truth aint pretty.

Well Said NursesRule....! Couldn't of said it better myself.....This is the heart of the matter! This is why nurses are being thrown under the buss! We are the last and most often the only advocate the patient has.....

They don't want the public to know the truth cuz the truth is ugly and the advocates job is to advocate for the patient when no one else can or will.....

Doctors are already fleeing from Medicare and Medicaid patients in droves...and it will only get worse by 2014...when you will either buy your own health insurance policy - or be fined and skewered by the IRS.

Unless we completely rid ourselves of Democrats this November, we are on a path to utter misery.

No one will enter medical school...with the pending Health Care Law in place.